Significance and consideration of scar revision surgery to improve the quality of life and psychological health of patients. Brief introduction to histological components of scars and factors to be considered with regard to affordability and suitability of scar revision surgery in different types of scars. Historical information including why the treatment of scars is necessary and a summary of the evolution of scar revision techniques. Brief overview of subsequent sections.
A scar can be taken as an indicator of a traumatic process of wound healing. Scars, on the face and body, may not significantly affect the health of the patient, but they do affect their daily life activities and can become an obsession for many people. It is also not just an external medical problem, but a psychological impact on people. Contrary to the process of healing healthy skin, scars contain collagen that is different from normal skin. Various treatments and medications concern the collagen of the skin. Also, the aesthetic improvement of scars to improve the appearance and quality of life is important to a patient; scar revision surgery can be recovery only. Scar revision is generally suitable for atrophic, hypertrophic, and keloid scarring, but it can include other problems that are important. Different scars have a different cause, healing, results, extent, and structure; the objects that suit scar revision surgery and the time of selection too will be different. In deciding surgical skill/treatment method and giving medical evaluation and answer to patients’ requests, the surgeon always has to consider the availability.
Modern surgery, as we recognize it, was born in the middle of the 19th century and developed throughout the 20th century with the premise that the treatment of wounds and burn injuries applied different pathophysiology than the treatment of their late scar sequelae; hence scars were avoided.
A number of factors contribute to the overall suitability of a person for undergoing scar revision surgery. They include – among others – the type of scar, the size of the scar, the age of the scar, the patient’s skin type, the patient’s anatomy, and any prior treatments performed. Factors that may make a patient unsuitable for scar revision surgery include, but are not limited to, systemic disease that could impair or prolong the healing process, keloid or hypertrophic scars, or skin type or skin quality that decreases the likelihood of significant improvement following surgery. Being generally healthy along with avoiding smoking can significantly increase a person’s suitability for scar revision surgery.
Patients with scarring remain actively changing with time. Hypertrophic and keloid scars can slowly increase in size over several months. It is recommended that surgical treatment should be delayed until optimal healing is confirmed and the scar’s growth is no longer active. Furthermore, when considering revision, in the case of a traumatic event leading to the scarring, the patient’s emotional state should be assessed to see whether any surgical intervention is appropriate. In addition, the age of the scar can influence surgical decision-making and of course, the size of the scar is also an important aspect. Recovery can involve swelling, bruising, and discomfort, and complete recovery depends on the size and quality of the scar revision surgery.
Once you have undergone a successful scar revision surgery, there will be a notable improvement in the appearance of the area. Aftercare will be provided on the day of the surgery and for the duration of the healing process. This will include dressings and advice on mobility, as well as follow-up check-ups to ensure the area is healing properly and that sutures are removed where necessary.
During the recovery process, it is likely that there will be some swelling and bruising of the area. This can last for up to two weeks. It is common for patients to experience some pain, which can be managed with over-the-counter medication such as paracetamol and ibuprofen. There can also be changes to the sensation of the skin on the treated area while the nerves are healing – this could present as a numb or tingly area. Stitches will generally dissolve on their own, but external stitches will usually be removed 3-7 days post-operation in a follow-up appointment. While the area is delicate, it is highly recommended that patients use a broad-spectrum SPF 50 that’s suitable for sensitive areas when going outside during daylight. As long as they are consulted, swimming can be resumed two weeks after the stitches have been safely removed. You will need to follow up with your surgeon in person or send photos in order to monitor the scar and healing for a good few weeks following surgery. Our nurses are available for any questions or concerns between appointments. A complete recovery will take a longer time, usually the upper end of 12+ months.
Aftercare follows the completion of the procedure, focusing on what will be required in terms of ongoing maintenance and care for the newly revised scar site. Patients may need to use a medicated ointment or new scar management products. At this point, plastic surgeons may schedule follow-up appointments in order to assess the site and determine if any long-term adjustments or special aftercare protocols are needed for that individual. The recovery period covers anything from a few days to a month. Some of the things to expect during this time include the use of dressings, bandages, or garments. In most cases, the return to work or activity can occur about a week after the surgery. Dermabrasion results in a 7 to 10-day recovery period.
Plastic surgeons may also recommend adjustments or important lifestyle changes to patients to ensure successful scar correction and limit the formation of new scars. This may also cover recommendations on how to maximize immune response and minimize scar inflammation. Long-term management will cover the necessity to monitor the sites for any signs of infection, bleeding, or complications in the weeks and months after the revision. Many of the elements covered in this section complement the physical and emotional recovery sections since they are also concerned with what the patient can do for themselves to speed up their recovery time and reduce scar-related complications. In many cases, immediate and short-term self-care strategies are the same or similar across most scar revision procedures.
The field of scar revision is one that is constantly evolving; innovations in technology as well as the emergence of noninvasive or minimally invasive topically applied therapies have enabled clinicians to offer a wider range of treatments for patients with visible scarring. A number of trials and case reports have recently been published in this field, and we will describe these new treatments as well as innovations in surgery. The papers that we review in this section are mainly based on case reports, small case series, and work still in progress, and we will touch on some potential future directions in the field of scar revision surgery.
In summary, scarring is a common sequela of surgical procedures and can be distressing to patients. Scar revision practices have evolved over time to optimize the aesthetic outcome and can be nonsurgical and surgical in nature. Light-based therapy as one modality of noninvasive potential is an area of growing interest in the field of scar revision. In scar prevention, some reports suggest that early intervention with intense pulsed light after surgical intervention could aid in minimizing any potential permanent visual fibrosis. In particular, the use of 532-nm Q-switched neodymium-doped yttrium aluminum garnet lasers has proven efficacy in treating hypertrophic scarring and keloids and has led to new opportunities in the management of pathologic scarring post breast reconstruction as one relatively new modality in combination with traditional therapies.